Summary

Here is a summary of today’s key events:

•The Francis report into the Mid Staffordshire hospital trust scandal, which led to the deaths of between 400 and 1,200 people, has recommended that causing death or harm to a patient should be a criminal offence. There should be more powers to suspend or prosecute boards and individuals, the report’s author, Robert Francis, recommended.

•A “duty of candour” should be imposed on NHS staff, the report said. Every healthcare organisation and everyone working for them must be honest, open and truthful in all their dealings with patients and the public, and organisational and personal interests must never be allowed to outweigh the duty to be honest, open and truthful.

•A single regulator for financial and care quality should be introduced, Francis said. There should be a single regulator dealing both with corporate governance, financial competence, viability and compliance with patient safety, and with quality standards for all trusts.

•David Cameron formally apologised for the care scandal at Stafford hospital and announced immediate moves to improve patient care, increase accountability of hospitals and tackle a culture of “complacency” in the National Health Service. He proposed establishing the new post of chief inspector of hospitals.

•Campaigner Julie Bailey shrugged off Francis’s insistence that no individual should be made a “scapegoat” by the report by calling for NHS chief executive Sir David Nicholson to step down. The Unite union agreed. But Cameron said Nicholson had apologised, implying that was sufficient. Jeremy Hunt, the health secretary, said it felt "wrong" that nobody had been brought to book over the failings at Stafford hospital.

•Professor Sir Bruce Keogh, medical director of the NHS, is tolead an investigation into hospitals that are persistent outliers in hospital performance and provide practical support for them. The Labour MP Ann Clwyd has been appointed by the government to undertake a review of complaints procedures in NHS hospitals.

•The chief executive of Mid Staffordshire NHS foundation trust, Lyn Hill-Tout, has apologised unreservedly for the board's failure to keep patients safe and care for them with compassion and dignity.

• Gagging clauses should be banned, the report said.

• Only registered people should care for patients, according to the report.

That's it from us. You can read all our Mid Staffs coverage past, present and future here. Thanks for all the comments.

As David Cameron said in his statement earlier, Professor Sir Bruce Keogh, medical director of the NHS, is to lead an investigation into hospitals that are persistent outliers in hospital performance and provide practical support for them. Those hospitals are:

The Care Quality Commission, the NHS regulator, has put out a statement welcoming Francis’s report and agreeing that “the NHS should maintain a positive patient-focused culture throughout”.

The CQC also welcomes David Cameron’s proposal for a chief inspector of hospitals, which the regulator says will “enable us to put a sharper focus on hospital care – really getting to grips with what’s most important to patients and their families”. The CQC sets out recent changes it has made to the way it conducts inspections, including:

• We will look more closely at how hospitals are run (simply put, do the doctors talk to the managers, do board members talk to patients, how well do hospitals learn from mistakes and complaints?). We will use more clinical experts in our inspection teams, (if it’s about nursing, we will take a nurse with us) and we will involve more members of the public with direct experience of hospital care - “experts by experience” - in our inspections

• We will look at how we can develop teams of specialist inspectors, who will work alongside clinical experts and people who use services.

• We will listen much harder to what people who use services tell us about the reality of the care they receive. And we will work more closely with others and use a wider range of information and evidence in our assessment of quality and performance.

The chief executive of Mid Staffordshire NHS foundation trust, Lyn Hill-Tout, has apologised unreservedly for the board's failure to keep patients safe and care for them with compassion and dignity. She said:

We apologise unreservedly that the board at Mid Staffordshire foundation trust and individuals working for the trust failed in their primary responsibility to keep all patients safe and to care for patients with the compassion and dignity they deserved.

We have learnt the hard way. We have learnt from that experience and, through listening to the Inquiry witnesses, our patients, staff and local community, we try every day to continue to improve the care we provide to our patients.

She added:

Since the start of the Healthcare Commission investigation in March 2008, our patients, local community and staff have been through very a difficult time. For some the difficulties continue. However, through the hard work of our staff, Stafford hospital is now a very different place.

The Labour MP Ann Clwyd has been appointed by the government to undertake a review of complaints procedures in NHS hospitals.

Last month Clwyd won widespread sympathy when she spoke out about the "almost callous lack of care" with which nurses treated her husband as he lay dying in the University Hospital of Wales in Cardiff.

Clwyd said today:

I welcome the opportunity to play an active role to help find a solution to one of the long list of problems we now have with healthcare in so many of our hospitals. I am determined that the result of this review will be a system that ensures that any complaint that patients or whistleblowers make will be listened to, and acted upon.

As the Patients’ Association said yesterday, every complaint is a chance to improve services, and to ensure mistakes are not repeated.

Jeremy Hunt, the health secretary, has just been speaking to Sky News. He said it felt "wrong" that nobody had been brought to book over the failings at Stafford hospital, backing the suggestion that failures to meet standards should be a criminal offence. Hunt said:

The hospital itself has made some important improvements. I think the more profound question is what do we do about the culture across the NHS.

The lesson of this report, and it's a very hard lesson for people like all of us who love the NHS, is that this is not just a problem about Stafford, because the system that was supposed to monitor what was happening in different hospitals completely failed to pick up what was going on.

Dr Judith Smith, director of policy at the Nuffield Trust, was an expert adviser on NHS organisation and commissioning to the Mid Staffordshire public inquiry. She writes on Guardian Professional that the Francis report shows the NHS "is not the glittering national treasure we would have it be, lacking in some places the basic humanity of care that we all expect." To Smith there are four initial steps that now need to be taken:

• Apologise to the patients and families in Stafford, and acknowledge their suffering and the failure of the NHS to heed this.

• Accept that Mid Staffordshire is almost certainly not a one-off, but symptomatic of wider problems.

• Make the quality of care, particularly of older people, a core national priority in practice as well as policy.

• Develop a clear and measurable action plan that addresses the core recommendations of the inquiry.

The prime minister has formally apologised for the care scandal at Stafford hospital and announced immediate moves to improve patient care, increase accountability of hospitals and tackle a culture of “complacency” in the National Health Service.

Among the fast-tracked reforms were proposals that hospital boards could be suspended for ongoing serious care failures, to introduce an element of performance-related pay for nurses, a new chief inspector of hospitals modelled on the Ofsted inspection agency for schools, and an inquiry into hospitals with the highest mortality rates nationwide ...

National reviews have also been ordered into the hospitals with the highest mortality rates, and how complaints are handled in the NHS, said Cameron.

David Cameron at prime minister's question time on 6 February 2013. Photograph: PA

Juliette also analysis the politics of the statement:

Cameron’s focus on quality of care, and his very conciliatory tone towards the Labour government in power at the time, will be seen as part of health secretary Jeremy Hunt’s strategy to shift the debate on the NHS from last year’s inflammatory reform of the health system structure to less divisive issues such as care standards.

However both sides will be aware that proposals such as performance-related pay and Labour’s immediate backing for the report’s call to benchmark staff numbers are likely to cause controversy as they emerge, something highlighted by Labour MPs using the debate to raise concerns about seriously understaffed hospitals.

In a notably consensual exchange, the Labour leader Ed Miliband also praised the vast majority of NHS staff, who he said “share our horror” at the “appalling betrayal” of events at Staffordshire hospital.

What Francis said about ...

•Mid Staffordshire NHS trust and the trust's board. While the wider NHS system did not act quickly enough on the warning signs emerging from Stafford hospital “those with the most clear and close responsibility for ensuring that a safe and good standard care was provided to patients in Stafford, namely the board and other leaders within the trust, failed to appreciate the enormity of what was happening, reacted too slowly, if at all, to some matters of concern of which they were aware, and downplayed the significance of others.

•GPs in the area. They only voiced concern about quality of care at the hospital after the Healthcare Commission, the NHS care watchdog at the time, announced it would investigate the trust. That was in 2008, three years after the poor care had begun.

•Local NHS primary care trusts. They “were under a duty to arrange for the provision of safe and effective care, [but] were not set up for and did not effectively ensure the quality of the health services they were buying”. In mitigation, though, Francis also added that the various PCTs, which commission and pay for treatment, “did not have the tools to do the job properly”.

•The strategic health authority. Francis said that the SHA, the regional representative of the NHS and Department of Health, “did not put patient safety and wellbeing at the forefront of its work”. Francis also accused the SHA of forgetting that its core purpose was to help the NHS improve patient care and of offering “false reassurance” to the DH about the trust's fitness to become a foundation trust.

•Monitor, which regulates semi-independent foundation trust hospitals and is due to become the NHS in England's overall financial regulator in April. It played a key role in Mid Staffordshire trust's application to become a foundation trust, semi-independent of Whitehall control. The watchdog was too quick to accept the trust's assurances that care at Stafford was good enough and should have “probed more deeply”. It continued to believe there was too little evidence to suggest major problems at Stafford long after it should have recognised them, thanks to the Healthcare Commission's damning findings. Monitor “focussed on corporate governance and financial control without properly considering whether there were issues of patient safety and poor care”.

•The Healthcare Commission, the NHS regulator until 2009. This is the only key NHS body to emerge with credit from Francis's dissection of the role played by a complex and interlinked plethora of organisations. It was its 2008-09 investigation that finally unearthed the appalling care at Stafford. While the seriousness of the inadequacy of care was so bad that independent performance management of the hospital was necessary, the NHS regulatory system at that time did not allow the HCC to do that. The HCC was wound up in April 2009 as part of a Labour government-ordered money-saving streamlining of the regulation of health, social care and disability.

•The Care Quality Commission, the successor to the HCC. Francis reserved some of his strongest criticisms for the CQC. He highlighted the fact that, when it began, it had a huge job: of merging the roles performed by until then three separate regulators and scrutinising a wide range of care providers. But as criticism of it grew it reacted with “a defensive institutional instinct to attack” its critics rather than embracing and learning from those criticisms. It has failed to adequately hold to account NHS care providers it is meant to be scrutinising and suffers from “a lack of clarity” about what the regulatory requirements it is charged with enforcing are based on, Francis says. The watchdog is also criticised for giving too little priority to various forms of patient information and feedback when deciding which hospitals to investigate. Despite Francis's remarks the CQC will see its role expanded to become in effect a new super-regulator of the NHS, if ministers implement his recommendations.

•The Department of Health. Unnamed officials “did not ensure that ministers were given the full picture when advising that the trust's application for foundation trust status should be supported. It was remote from the reality of the service at the front line”, said Francis. Crucially, in addition “it is not possible to avoid the impression that it lacks a sufficient unifying theme and direction, with regard to patient safety, to move forward from this point in spite of the recent reforms put in place by the current government.”

Mike Farrar, the chief executive of the NHS Confederation, which speaks for all the organisations that commission and provide NHS services, praises Francis's proposals for getting the whole system behind the objective of "putting patients at the centre of the NHS", but adds:.

There will of course be practicalities, including cost-effectiveness and whether all recommendations do what they say on the tin. But let's not lose sight of the big picture. This is an opportunity to make the NHS safer, more compassionate and fully accountable to the people it serves.

We particularly welcome: the focus on culture, not on structures; on making our regulatory system more effective; on strengthening local commissioning which now has clear responsibility for driving improvement; on transparency and candour; and on listening to staff and patients and acting on their concerns.

We owe it to every patient, family member and carer to commit to making sure these sorts of tragedies do not happen again. It is up to all of us in the NHS to take responsibility for putting things right.

In the Commons, Tory MP Chris Skidmore just asked David Cameron about comments made in 2008 by NHS chief Sir David Nicholson and detailed in Francis’s report on page 1,312 of volume two.

The report says that Nicholson warned against:

a local campaign group in existence against Mid Staffordshire for some time. Clearly patients needed to express their views but he hoped the Healthcare Commission would remain alive to something which was simply lobbying or a campaign as [opposed] to widespread concern.

The report says Nicholson could not recollect making this comment.

Skidmore said:

I found those comments from the head of the NHS at the time utterly unacceptable. Does he agree and will he investigate Sir David Nicholson’s comments?

Cameron replied:

He’s right to raise the issue that he does. I think we should be clear though that David Nicholson has apologised very publicly and very repeatedly for the failure of the strategic health authority, which he was in charge of for some important months during this whole approach. The report is clear that we should not be trying to seek individual scapegoats … In my view David Nicholson has a deep affection for our NHS does a good job on the NHS commissioning board and he has thoroughly apologised and recognised his responsibilities for what went wrong in Stafford. The trust board were overwhelmingly responsible.

The Unite union is joining campaigner Julie Bailey in calling for the NHS chief executive Sir David Nicholson to resign over the Mid Staffs scandal. Rachael Maskell, the union's health officer, said:

Sir David Nicholson, who has thrown down the so-called Nicholson challenge of £20bn cuts, is not the person to lead the NHS into the world of patient-focused care as outlined by Robert Francis. A complete overhaul of dysfunctional management in the NHS needs to happen as a matter of urgency and the first person out the door should be Sir David Nicholson, chief executive of the NHS commissioning board – perhaps the most powerful person in the coalition’s new NHS.

In 2005, he was the regional NHS official who had the oversight of Mid-Staffs when the clinical failures were taking place. Later, as a NHS chief executive, he had accountability as to how the NHS responded as the scandal unfolded. The words ‘buck’, ‘stopping’ and ‘here’ have a certain resonance.

Stephen Dorrell, the well-respected head of the health select committee and former health secretary, says that "the key to high care standards will always be the commitment and professionalism of the clinical staff. Management objectives are important, but they can never be allowed to become an excuse for poor care."

He notes:

Among his recommendations is the proposal that the health committee of the House of Commons should monitor the application of his recommendations by the professional regulators. We shall certainly be following up that recommendation.

Summary

•Causing death or harm to a patient should be a criminal offence. There should be more powers to suspend or prosecute boards and individuals. A service incapable of meeting fundamental standards should not be permitted to continue. Any breach should result in regulatory consequences, attributable to an organisation in the case of a system failure, and to individual accountability where individual professionals are responsible. Where serious harm or death has resulted to a patient as a result of a breach of the fundamental standards criminal liability should follow.

•A “duty of candour” should be imposed on NHS staff. Every healthcare organisation and everyone working for them must be honest, open and truthful in all their dealings with patients and the public, and organisational and personal interests must never be allowed to outweigh the duty to be honest, open and truthful. The NHS constitution should be revised to reflect the changes recommended with regard to a duty of openness, transparency and candour, and all organisations should review their contracts of employment, policies and guidance to ensure that, where relevant, they expressly include and are consistent with above principles and these recommendations.

•A single regulator for financial and care quality should be introduced. There should be a single regulator dealing both with corporate governance, financial competence, viability and compliance with patient safety, and with quality standards for all trusts.

•Gagging clauses should be banned. Gagging clauses or non-disparagement clauses should be prohibited in the policies and contracts of all 22 healthcare organisations, regulators and commissioners; insofar as they seek, or appear, to limit bona fide disclosure in relation to public interest issues of patient safety and care.

•Only registered people should care for patients. A registration system should be created under which no unregistered person should be permitted to provide direct physical care to patients currently under the care and treatment of a registered nurse or a registered doctor (or who are dependent on such care by reason of disability and/or infirmity) in a hospital or care home setting. The system should apply to healthcare support workers. This approach is applicable to all patients but requires special attention for the elderly.

• It should be clear who is in charge. Hospitals should review whether to reinstate the practice of identifying a senior clinician who is in charge of a patient’s case, so that patients and their supporters are clear who is in overall charge of a patient’s care.

•The health secretary should consider transferring the functions of regulating governance of healthcare providers and the fitness of persons to be directors, governors or equivalent persons from Monitor to the Care Quality Commission.

• The Care Quality Commission should develop a specialist cadre of inspectors by thorough training in the principles of hospital care.

• Those charged with oversight and regulatory roles in healthcare should monitor media reports about the organisations for which they have responsibility.

• Directors should be ‘fit and proper’. There should be a requirement that all directors of all bodies registered by the Care Quality Commission as well as Monitor for foundation trusts are, and remain, fit and proper persons for the role. Such a test should include a requirement to comply with a prescribed code of conduct for directors.

•Complaints should be published on hospital websites. Subject to anonymisation, a summary of each upheld complaint relating to patient care, in terms agreed with the complainant, and the trust’s response should be published on its website.

•GPs need to undertake a monitoring role on behalf of their patients who receive acute hospital and other specialist services.

• Local authorities should be required to pass over the centrally provided funds allocated to its local Healthwatch (the new “consumer champion” body for health care), while requiring the latter to account to it for its stewardship of the money.

Julie Bailey, founder of Cure the NHS, after her mother died at Stafford, has said patients are still looking for resignations. First targeting Sir David Nicholson, now the NHS in England's chief executive, but then its regional head, she said: "We are not scapegoating anybody but the man at the top of the NHS has not got the leadership skills to take this report forward. We don't want a bully at the top of this organisation."

She also called for the head of Peter Carter, chief executive who she has accused previously.

Cameron creates chief inspector of hospitals post

The regulatory bodies have some difficult questions to answer, he says. No one has been struck off. The Health and Safety Executive needs to explain why no one was prosecuted. Cameron will look carefully at moving that function to the CQC.

We need the words of patients and frontline staff to be taken seriously by the boards, the regulators and the Department of Health. Cameron runs through the government's "friends and family check" policy whereby staff are asked if they would be happy for their friends and family to be treated there.

Cameron says the suffering was primarily caused by a failure by the board, which tolerated poor standards and was disengaged from management responsibilities.

The primary care trust assumed others were taking responsibility. The strategic health authority was too remote from patients. Regulators Monitor and the HCC failed to protect patients. Doctors failed to speak out. The Royal College of Nursing was ineffective. the Department of Health was too remote.

But Francis does not blame any specific policy or the last health secretary, Cameron says.

Clare Gerada of the Royal College of GPs says what happened at Mid Staffs was "system failure of the highest order":

At a time when the NHS is under greater than ever financial pressure, it is imperative that the needs of patients are put first, and that cuts are not made which could jeopardise the safety of patient care.

Two major changes must happen in the wake of the Francis report if we are to provide the necessary reassurance that the lessons of Mid Staffs have been learnt and, most importantly, that the same mistakes will not be repeated elsewhere in future. Firstly, we need to refocus and restore patient care back to its rightful place at the heart of everything we do, across the entire health service from the most junior healthcare assistant to the most senior consultant. Clinicians, including GPs and their teams, must be given the ability to do what is most important: listening to patients and caring for them. GPs have so far ridden the storm but financial constraints and top-down targets are starting to adversely affect the level of care we can deliver to our patients. We need to reverse this trend by increasing the number of GPs available to provide patient care, and by ensuring they are free to focus their attention on what matters most to patients.

The second lesson we must take from the Francis report is the need to create an environment in which health professionals right across the NHS can raise concerns on behalf of their patients without fear of recrimination, and where concerns will be properly and thoroughly investigated. In anticipation of the report, the RCGP has produced a UK-wide position statement on raising concerns and whistle blowing in the NHS that we hope will prove invaluable for GPs, hospital staff and patients.

Katherine Murphy of the Patients' Association welcomes the report. She says:

This is a watershed moment for our health service ... [Francis] has recognised what we hear on our helpline every day - too many parts of the NHS has lost its way and forgotten that care and compassion should be at the heart of what staff do. He wants to give nursing a powerful voice. He wants the ward sister back in charge and we welcome that. The concept of a registered older people's nurse is a great idea and should be wholeheartedly pursued. Whilst he recognises it will take some time to implement, he has seen that there can be no other option but to regulate healthcare assistants. The government has been wrong to resist this idea.

Cathy Warwick of the Royal College of Midwives calls the duty of candour suggestion "excellent". She says:

We hear far too often from midwives who are genuinely petrified about raising the alarm bell over poor quality of care. They fear that senior managers will come down on them hard simply for raising concerns. We need to transform the culture of the NHS so that midwives and others who need to raise concerns feel happy and secure in doing so. NHS staff must never again be afraid to raise concerns about standards of NHS care. Today must be a watershed for the NHS.

At PMQs, Cameron is asked about whether he is still committed to increasing funding in the NHS. He says he is. The number of managers and administrators is "right down" and the number of clinical staff is right up, the PM says.

Action against Medical Accidents welcomed the new measure making it a statutory duty for NHS staff to own up to their mistakes, a core recommendation from Francis.

It has been campaigning strongly for this.

Chief executive Peter Walsh said ministers must accept the recommendation, "which would represent the biggest advance in patient safety and patients' rights in the history of the NHS," he said. Walsh added:

So far they have fiercely resisted this. The duty of candour, together with other recommendations to ensure full openness and transparency, represent a new dawn for the NHS. Organisations that sweep errors under the carpet do not learn lessons. An open and transparent NHS will be a safer NHS.

Summary

• Causing death or harm to a patient should be a criminal offence, Robert Francis says.

• A “duty of candour” should be imposed on NHS staff.

• Everyone having hands-on care of a patient should be properly trained and registered.

• Senior NHS staff who breach the code of conduct should be disqualified.

• Accurate, useful and relevant information should be shared between everyone who needs it.

• This scandal cannot be dealt with by sacking “scapegoats” and reorganising the NHS again, Francis says.

• The business of the NHS system was put ahead of the wellbeing of patients, he says. Multiple failures by a wide array of organisations and individuals across “the NHS system” allowed poor care to persist.

• The Mid Staffs trust board was weak and did not listen to patients and staff, Francis says. There was a “serious failure” of its duties by the trust’s board of directors.

• This is a story of appalling and unnecessary suffering, he says.

• He is calling for a "zero tolerance" approach to poor standards of care.

• Francis calls for the creation of in effect one new super-regulator for the NHS which would scrutinise both clinical and financial standards. These tasks are currently performed by two watchdogs, the Care Quality Commission and Monitor.

In answering the question of why hundreds of patients died needlessly at the mid-Staffordshire trust in the years between 2005 and 2008, Robert Francis QC has identified a culprit: the NHS's culture which focused "on doing the system's business - not that of the patients", writes Randeep Ramesh.

A sharp legal brain, Francis has in four volumes and almost 2,000 pages cleverly side-stepped the need for a system overhaul to avoid the disastrous failures of those three years. Instead he focuses on a system reset with better warning signals, criminal penalties for not acting on breaches of fundamental standards and greater accountability of senior managers.

Francis sees the health service during these years as almost akin to a cult of managerial ideology - seeing the glass half-full when in fact it was empty. He says "poor standards" risking patient care was tolerated and there was an "institutional culture" which "ascribed more weight to positive information about service than to information capable of implying cause for concern".

In short it was the culture that did it. To change this means for actors in the system - managers, doctors and civil servants - to change they way they do business. Francis goes as far as suggesting a "cultural barometer" to measure the internal health of relationships between frontline nursing and managers. There's a recommendation for a duty of candour to be placed in the NHS' constitution obliging hospitals to be "honest, open and truthful", effectively an admonishment for past misdeeds. And Francis' calls for an end the gagging clauses which some health service organisations, notably the Care Quality Commission, used frequently.

In what will be the biggest political battle will be the creation of a new super-regulator, essentially based on the current CQC. The loser here is Monitor, which the coalition saw as the economic regulator, in the new NHS with the CQC dealing with quality. Instead Francis sees the two issues as intimately related and calls for a "single regulator dealing with both corporate governance, financial competence, viability and compliance with patient safety".

The coalition's blueprint wanted this separation, but Francis says that there important information about mid Staffs was not "passed from one organisation to another" leading to a breakdown in the assessment of the trust. This appears to be Monitor's downfall - and instead it will be left, if Francis is implemented as the previous health secretary Andrew Lansley suggested, as merely a competition body.

In anticipating the report Jeremy Hunt, the health secretary, has put into place better systems for dealing with failure - both clinical and financial - in the NHS. There's been a determined push to deal with bankruptcy in the face of public protest. And his call for an Ofsted-style ratings for hospitals will help. The coalition was want doctors to be rated better and for the public's assessment via the friends of family test to take pride of place in the new system.

The scale of the Francis report cannot be underestimated. Its assessment is a damning one on the health service that was struggling with a multitude of problems and at a time of great change. The NHS was not designed to let hundreds die but that is what has happened. It is time for a change.

Francis's five key points

We need a commitment by all who work with patients to serve and protect them, Francis says.

He warns again against "more radical reorganisation" in the health service.

Five things are needed now, he says:

•Clearly understood fundamental standards. To cause death or harm to a patient by non-compliance should be a criminal offence. This must be policed by the CQC.

•Openness, transparency and candour throughout the system. A duty of candour should be imposed and underpinned by statute and the deliberate obstruction of this duty should be a criminal offence.

•No one should have hands-on care of a patient without being properly trained and registered. He calls for a new registered status for those working with older patients.

•Strong patient-centred healthcare leadership. The public are entitled to see leaders held to account. It should be possible to disqualify those seriously breaching the code of conduct. This will require a registration scheme.

•Accurate, useful and relevant information. Patients should also have access to this. Difficulties in achieving this are no excuse for inaction.

Report published

The embargo on the report has been lifted. Denis Campbell reports:

Hospital staff and managers should face prosecution if patients are harmed or killed as a result of poor care as part of sweeping changes to finally end the NHS's neglect of patient safety, the landmark report into the Mid Staffordshire scandal recommended today.

The report by Robert Francis QC amounted to a damning indictment of NHS attitudes, practices and organisations.

Francis made no fewer than 290 recommendations, which he said were designed to ensure that patients' interests became the top priority for the NHS and that in future any lapses in care standards are detected and stopped right away, unlike at Stafford hospital.

David Cameron will deliver the government's response later this morning. Ministers will now have to contemplate further changes to the NHS's system of regulation – which Francis has found to be seriously wanting – and monitoring of hospitals.

While the hospital trust itself bore most of the responsibility for allowing “appalling suffering of many patients” to go unchecked between 2005 and 2009, multiple failures by a wide array of organisations and individuals across “the NHS system” allowed poor care to persist and meant opportunities to intervene were not taken, Francis said.

Patients were left at risk at the hospital even after the then NHS regulator sounded the alarm about unusually high death rates there, he added. Checks and balances designed to protect patients did not prevent “serious systemic failure of this sort”,

In a scathing assessment of the trust's board of directors, Francis accused it of a “serious failure” of its duties:

It did not listen sufficiently to its patients and staff or ensure the correction of deficiencies brought to the trust's attention. [It also] failed to tackle an insidious negative culture involving a tolerance of poor standards and a disengagement from management and leadership responsibilities.

But he also cited the hospital A&E unit's need to treat 98% of patients arriving there within four hours to meet the government's key NHS targets, the trust's attempts to balance its books, and its “seeking foundation trust status … at the cost of delivering acceptable standards of care” as contributory factors.

Francis said that in future the NHS should have a relentless focus on fundamental standards of care which, if breached, should lead to serious sanctions.

“Any service or part of a service that does not consistently fulfil the relevant fundamental standards should not be permitted to continue,” Francis said, in a move which could see hospital units where concerns arise shut down.

In addition, “non-compliance with a fundamental standard leading to death or serious harm of a patient should be capable of being prosecuted as a criminal offence, unless the provider or individual concerned can show that it as not reasonably practical to avoid this,” he recommended.

He also recommended the creation of in effect one new super-regulator for the NHS which would scrutinise both clinical and financial standards. Those tasks are currently performed separately by two watchdogs, the Care Quality Commission (CQC), which regulates care, and Monitor, which regulates semi-independent foundation trust hospitals and is due to become the NHS in England's overall financial regulator in April.

Robert Francis, chair of the inquiry, is a QC specialising in the NHS and medical negligence. He has spent years examining the causes of the Stafford hospital scandal and, to quote our health correspondent Denis Campbell's profile of him, is "highly skilled at getting to the truth and quietly scathing when he feels censure is due."

For me, the most worrying aspect of the report is the apparent lack of compassion from some staff. This goes against the grain of what most of us most value in a caring service such as the NHS. Whether the result of individual actions or of a system which is understaffed and under pressure, some of the stories that emerged from Mid Staffs and from our own inquiry, are a source of major concern.

Linked to this is the failure to listen to the voice of patients. In Mid Staffs there were warning signs from patients themselves which should have prompted earlier action. Involving and listen to people who use services, despite the political rhetoric, is still seen as a peripheral activity and the hearts of many managers and clinicians are not really in it.

Finally, there is the sense of a lack of leadership when it comes to quality. At Mid Staffs this included a lack of focus from the Board and senior management. Quality is everybody’s business but in complex systems such as healthcare, leadership is crucial to setting culture, priorities and holding the system to account for delivery. Sadly at Mid Staffs other things besides the quality of care delivered appeared to be more important and, more worryingly, were allowed to be important by those managing and regulating the system.

Meanwhile health sector commentator and former Labour adviser Paul Corrigan predicts on his blog that a number of newspapers (including the Sunday Times and the Telegraph) will look for findings that chime with their anti-NHS stance, adding:

The main thing to do for those of us that care for the NHS is to ignore the attack of these few and concentrate on how quickly the NHS can learn from what went so wrong in Mid-Staffs.

I have always believed that the NHS is a very strong organisation – one that can learn how to care better from as wide a range of lessons as possible. Some others – also, I admit, friends of the NHS – want to keep the whole structure as it has always been. Personally I have always felt that this approach regards the NHS as being much more fragile than it is.

As a strong organisation with deep roots bedded in a belief of who we are as a country, it has the strength to look very closely at what it is and how it operates. And with that strength it can change through learning.

So despite what a few embittered rightwingers may say, Francis is NOT an attack upon the basic principles of the NHS. It’s important that we don’t react to it in that way – because that is not what it is. It is an attack (correctly) upon some appalling practices that took place within those principles.

The NHS will be able to learn these very difficult lessons and improve the way in which universal socialised medicine works for us all.

And the HSJ has put up this podcast, in which their reporter Shaun Lintern, who originally covered the story as a local reporter, explains the significance of the report.

The Care Quality Commission, the current health service regulator, will be awaiting the verdict of the inquiry nervously. Although the scandal at Stafford hospital happened on the watch of its predecessor the Healthcare Commission, the CQC has had its own problems.

As Stephen Dorrell, chair of the Commons health select committee, put it last month, its "primary focus should be to ensure that the public has confidence that its inspections provide an assurance of acceptable standards in care and patient safety. We do not believe that the CQC has yet succeeded in this objective."

You only had to open a ward door at the hospital to smell the stench of urine, hear patients screaming in pain and see staff being bullied, and know that the care was appalling. But the people in charge chose not to do that.

She also calls for Andy Burnham, Labour health secretary from 2009 to 2010, and currently shadow health secretary, to step down, writing:

This shift away from patient care started to happen under the Labour government. It destroyed the culture of care in the NHS by replacing it with a top-down, target-driven culture. Former health secretary Andy Burnham contributed to this. He wouldn't even meet the grieving relatives at Stafford hospital and he only gave us a secret inquiry so that the NHS's dirty linen wouldn't be aired in public. Burnham must resign and have nothing more to do with health policy.

Mike Farrar, the chief executive of the NHS Confederation, which speaks for all the organisations that commission and provide NHS services, is warning against more external regulation of hospitals and the post of chief inspector of hospitals, which the BBC reports that Francis will recommend the creation of today. Farrar told BBC Breakfast:

We shouldn't be relying on external inspectors to create the right climate and the right attitude in hospitals. Staff give really, really great care when they feel really, really valued - not really, really inspected.

Farrar said the Mid Staffs staff had suffered from “an institutional blindness” by ignoring failings at the trust.

As someone who came into the health service, like very many other people, to do good, I think today is a day where I genuinely feel shame. We can't ignore the responsibility right at the ward level; that's where care is given. But then we have to understand what the hospital management was doing about things at ward level in that hospital. And we have to understand how the whole system, the regulatory system, failed to identify that things were a problem soon enough and act on it.

Julie Bailey, a leading campaigner on the Mid Staffs controversy, told ITV’s Daybreak this morning that relatives of victims wanted to see people held responsible for the scandal.

Her mother, Bella Bailey, died at Stafford hospital in 2007 aged 86.

Julie Bailey said:

We won't be going anywhere until there is a safer NHS, but things have got to change at the top. We are looking for accountability for this; we can't lose all these lives and nobody be held to account. We can’t allow that.

She added:

When mum went in, we both believed the NHS was something to be proud of, we both believed that the hospital would be a safe place. We quickly learned after four days that mum was in fact in a very dangerous place. She needed protecting in what should have been a place of safety.

We believe the NHS has just lost sight of what it is there for - the patient. Everybody looks up in the NHS, nobody looks out to what the patient wants and what the patients need.

Emma Jones, a human rights lawyer at Leight Day, said her firm was investigating claims of abuse at 10 other hospitals:

Every day abuse against patients takes place, and it is usually the most vulnerable who suffer, and without widespread reform it will continue. People who are admitted to hospital are vulnerable. They are often frightened and have not been told what is wrong with them, or what treatment they will receive. These issues need to be addressed and reforms put into place as a matter of urgency to ensure such a situation does not arise again.

Katherine Murphy of the Patients’ Association said the government needed to urgently address the “care deficit” in the health service:

Whilst our first thoughts must be for those families and friends who lost loved ones so tragically in Mid Staffs, every possible action must be taken to avoid such an appalling scandal ever happening again. Our helpline hears from patients, relatives and carers every day who raise concerns about basic standards of care and safety - from not receiving adequate pain relief to a lack of assistance to go to the toilet - not being met. There are a number of urgent issues the government and the NHS must confront to address this care deficit and provide the highest quality services possible. Whatever the specific recommendations are from the Francis Inquiry, a fundamental shift in the culture of NHS organisations so that both appalling and good care are viewed as learning opportunities is crucial.

This morning at 11.30am the Francis report into the failure of NHS managers and regulators to identify and act upon the problems at Mid Staffordshire hospital trust that led to between 400 and 1,200 deaths between 2005 and 2009 will be published.

Robert Francis QC, chair of the inquiry reporting today, is expected to recommend wide-ranging reforms of the NHS, reportedly including the suggestion that hospitals that cover up doctors’ mistakes and offer patients poor treatment should face fines and possible closure. He is also set to criticise a self-protecting elite among NHS managers and regulators that refused to take seriously complaints from patients or relatives.

• Tough new scrutiny, with beefed-up teams of inspectors including more doctors and nurses rather than those from social care backgrounds.

• An overhaul of the series of regulatory bodies that currently examine hospitals, and failed in the case of Mid Staffs.

• More regular and further-reaching inspections.

• Better collection and sharing of different sources of information about hospital care by the Care Quality Commission, the health regulator, including patient complaints, media reports, results of clinical audits, and financial information.

He may also propose legal minimum staffing levels, as some campaigners have asked him to.

Among the NHS managers, health professionals and regulators who may be criticised today are:

The government will have to decide which of Francis’s recommendations it will enact – and who to sack over the controversy. Nicholson seems an obvious target, but he may have become indispensable to ministers, as Patrick Butler explains.

Here is a rough schedule of today’s key events:

10am: The report is received by the media.

11.30am:A reporting embargo is lifted and the findings will be published.

11.35am:Francis will make a statement on his findings.

Midday: Prime minister’s question time. David Cameron may be asked about the report.

12.30pm: Cameron will make a statement on the report.

It is estimated that because of substandard care between 400 and 1,200 more patients died at Stafford hospital between 2005 and 2009 than would have normally been expected. This is the fifth inquiry into the failings at Mid Staffordshire NHS foundation trust that led to these deaths.

An independent investigation by Francis in 2010 found that Mid Staffs had “routinely neglected patients” and revealed how the trust had cut staff, especially nurses, and neglected quality of care as it sought to balance its books in its determination to become a foundation trust.

The report found that some patients had been left for hours sitting in their own faeces, many patients had relied on relatives to ensure they ate and drank because food and drink was left out of their reach, misdiagnosis of medical problems had been common, pain-relieving drugs had not been given or had been given late, and hygiene had been so poor that relatives had had to clean toilets themselves to avoid catching infections. "Many suffered horrific experiences that will haunt them and their loved ones for the rest of their lives," said Francis in his 2010 report.

A public inquiry was ordered following Francis’s 2010 investigation, and it is this that is reporting its findings today. The current inquiry – also carried out by Francis – is into the bodies meant to be monitoring the trust, and it is meant to identify why serious problems were not spotted and acted upon sooner and identify important lessons for the future.

A separate, highly critical report by the Healthcare Commission in 2009 revealed a catalogue of failings at the trust and said “appalling standards” had put patients at risk.

Mike Farrar, the NHS Confederation chief executive, has predicted that the release of today’s report could be “one of the darkest days” in the history of the NHS.

Yesterday Cameron and Jeremy Hunt, the health secretary, received their copies of the report. The PM also met representatives of victims’ families at Downing Street.

We’ll be covering the publication of the report and all the fallout from its findings here throughout the day.